Carcinoma Arising in Bowen's Disease

Bowen's disease (BD) is generally regarded as a premalignant dermatosis.1-3If untreated, 3% to 5% of patients may develop invasive carcinoma, which is capable of metastasizing and may even cause death.3, 4Clinically, the lesions of BD present as a scaly, slightly elevated, erythematous plaque with surface fissures and foci of pigmentation. These lesions affect fair-skinned individuals more frequently and are equally distributed on the exposed and nonexposed parts of the body. Microscopically, BD is a form of carcinoma in situ characterized by full-thickness involvement of the epidermis and the pilosebaceous epithelium by atypical keratinocytes. The papillary dermis shows a dense, chronic, inflammatory infiltrate compound of lymphocytes, histiocytes, and plasma cells. Bowen's disease with invasive carcinoma (BD-CA) is not well recognized by clinicians because of its rarity and lack of specific clinical features. The lesion is often diagnosed as seborrheic keratosis, basal cell carcinoma, squamous cell carcinoma, BD,